12 South LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

12 SOUTH LLC

Practice address

23712 Birtcher Drive
Lake Forest, CA 92630

Phone

(888) 830-8374

Fax

(949) 215-6650

NPI assigned

Feb 10, 2016

Last updated

Nov 2, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kyle Smith

Title

Ceo/Owner

Phone

(888) 830-8374

Specialties & licenses 3

Addresses

Other names 1

• 12 South Recovery Other name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gabriella Kamara, APCC

  • Professional Counselor
  • Lake Forest, CA
  • NPI 1609536051
  NPD
• Alejandro Alva, M.D.

  • Psychiatry Physician
  • Costa Mesa, CA
  • NPI 1801816764
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1154789766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23712 BIRTCHER DRIVE",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "92630",
            "telephone_number": "714-579-9304",
            "fax_number": "949-215-6650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23712 BIRTCHER DRIVE",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "92630",
            "telephone_number": "888-830-8374",
            "fax_number": "949-215-6650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "12 SOUTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-10",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "888-830-8374"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "12 South Recovery",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Aa Grant (BrightStar Healthcare)

• Substance Abuse Rehabilitation Facility in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.